Variant Presentations of Mycetoma among Immunocompetent Patients attending a Tertiary Care Center in North Karnataka, India

Mycetoma is a pathological process in which eumycotic (fungal) or actinomycotic causative agents from exogenous source produce grains. It follows penetrating injury of the skin inoculating soil organisms, occurring preferentially in rural areas usually among labourers who walk barefoot. Mycetoma is a localized chronic and deforming infectious disease of subcutaneous tissues, skin and bones. Here we present such variants among immunocompetent individuals. These myriad manifestations will add to the acumen of practicing Dermatologists and aid in early diagnosis. A total of 3 cases of mycetoma presented to us in the preceding 2 years. Presentation varied from persistent swelling of foot, multiple sinuses, discharging grains, pain and deformity, osteolytic lesions in X-ray, chest wall involvement, purulent discharge from sinuses. Clinical, laboratory, and radiological data were obtained from retrospective case record analysis of patients admitted at our hospital. Etiological workup revealed the following causative organisms responsible for mycetoma-Actinomycosis (Actinomadura madurae)-2, Eumycetoma (Madurella grisea)-1. If patients presented with triad of swelling, multiple sinuses, discharging sinuses is sure sign of mycetoma. Distinction between eumycetoma and actinomycetoma is very important for the treatment.